Hemodynamic Characteristics of Patients With Suspected Coronary Heart Disease at Their Initial Visit.

Haoyao Cao,Mao Chen,Yiming Li,Tinghui Zheng,Yiming Zhao,Tianyuan Xiong,Zhan Liu

doi:10.3389/fphys.2021.714438

Abstract

PurposeIt is difficult for doctors to decide whether patients with suspected coronary heart disease classified as Coronary Artery Disease Reporting and Data System (CAD-RADS) < 3 should be administered preventive treatment, or whether non-atherosclerotic chest pain should be considered. The aim of the current study was to investigate coronary hemodynamic characteristics in such patients, which may provide more information on their stenosis and be helpful for initial diagnoses.MethodsTwo patient-specific models were reconstructed based on the coronary computed tomographic angiography underwent in 2012. Patient 1 was classified as CAD-RADS 0, and was readmitted to hospital due to coronary artery disease within 5 years. Patient 2 was classified as CAD-RADS 2, and has experienced no adverse events to date. Computational fluid dynamics (CFD) analysis was used to obtain hemodynamic parameters including flow rate waveform, flow streamlines, time-average wall shear stress (TAWSS), and oscillatory shear index (OSI).ResultsPatient 1 exhibited no physiological characteristics of right coronary artery flow waveform, large areas of low TAWSS, and slow blood flow in the proximal and middle segments of the left anterior descending branch. Patient 2 exhibited reduced coronary supply, small and separate areas of abnormal TAWSS, and a higher left anterior descending branch OSI than patient 1.ConclusionHemodynamic abnormalities may play an important role in the prognosis of patients with coronary stenosis, and patient-specific hemodynamic characteristics may facilitate more accurate initial diagnosis, and better management. Overall hemodynamics (along the whole vessel) warranted attention at the time of the initial visit in patients classified as CAD-RADS < 3.

Highlights

Coronary artery stenosis is one of the most contributory components of acute coronary syndrome and sudden cardiac death
The current study suggests that overall hemodynamics are worthy of attention, especially in patients classified as CAD-RADS < 3 at the time of initial diagnosis
The patient classified as CAD-RADS 0 had abnormal hemodynamic characteristics that could not be ascertained from the Coronary computed tomographic angiography (CCTA) directly

Summary

Introduction

Coronary artery stenosis is one of the most contributory components of acute coronary syndrome and sudden cardiac death. The Coronary Artery Disease Reporting and Data System (CAD-RADS)—based on the highest-grade stenosis recorded by CCTA—provides specific suggestions for further management of patients with suspected coronary heart disease (Cury et al, 2016). Patients classified as CAD-RADS ≥ 3 (stenosis degree ≥ 50%) are diagnosed with “coronary heart disease” and administered a widely accepted planning treatment aimed at avoiding the occurrence of myocardial ischemia, hypoxia, and necrosis (Miller et al, 2008; Alexopoulos et al, 2010; Roffi et al, 2015; Cury et al, 2016). There are some patients in whom the risk of coronary heart disease is excluded based on “minimal” coronary stenosis at the time of their initial diagnosis, but who go on to suffer coronary artery plaque after a period of months or years without anti-atherosclerosis treatment (Pflederer et al, 2010; Lee et al, 2019). Accurate diagnosis and timely treatment of patients classified as CAD-RADS < 3 is crucial

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